Micturition Flashcards

1
Q
  • What makes up the upper urinary tract?
  • What makes up the lower urinary tract?
A
  • Kidney, Ureters
  • Bladder, Urethra
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2
Q
  • Describe what happens physiologically with a blockage or ureteral outflow
  • What is a common presentation?
A
  • Blockage in the ureters leads to an increase in hydrostatic pressure and ureteral dilation
  • Paroxysmal pain (pain when ureters contract) and hydronephrosis (which puts the pt at increased risk for ARF-acute renal failure)
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3
Q
  • Where can anatomic constrictions occur?
A
  • Ureteropelvic junction
  • Testicular/Ovarian artery and vein
  • External iliac artery and vein
  • Bladder wall
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4
Q
  • What happens in vesicoureteral reflux?
  • What is the patient at increased risk of developing?
A
  • Ureteral dilation and urine traveling back up into the ureters
  • Increased risk for pyelonephritis
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5
Q
  • What three openings and muscle make up the trigone?
  • Where is it located in respect to the bladder?
A
  • Two ureteral openings and internal uretheral sphincter as well as the detrusor m.
  • Found on the posterior bladder wall.
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6
Q
  • The intravesical pressure stretch signals activate sensory nerve fibers. With what two anatomical features does this afferent fiber travel with?
  • Where does it travel to?
A
  • Pelvic splanchnic nerve and hypogastric plexus
  • S2-S4 (Sacral micturition center)
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7
Q
  • What types of afferent fibers sense bladder fullness? Are they myelinated or unmyelinated?
  • What type of afferent fibers sense bladder pain? Are they myelinated or unmyelinated?
A
  • Alpha delta-myelinated (bladder fullness)
  • C fibers-unmyelinated (bladder pain)
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8
Q
  • Parasympathetics activate which nerve?
  • What spinal levels is this nerve associated with?
  • What muscles contract/relax as a result of parasympathetic stimulation?
  • What type of receptor?
  • What NTX?
A
  • Pelvic splanchnic nerve
  • S2-S4
  • Detrusor muscle contracts and internal uretheral sphincter relaxes
  • M3 muscarinic
  • ACh
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9
Q
  • Sympathetics activate which nerve?
  • What spinal levels is this nerve associated with?
  • What muscles contract/relax as a result?
  • What type of receptors are activated?
  • What NTX is responsible?
A
  • Hypogastric
  • L2
  • Detrusor muscle relaxation and internal uretheral sphincter contraction (so the opposite of the parasympathetics)
  • Urethra-alpha 1; Detrusor M (b2 and b3)
  • NE
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10
Q
  • Somatics activate which nerve?
  • What spinal levels is this nerve associated with?
  • What muscles contract/relax as a result?
  • What receptors are involved?
  • NTX?
A
  • Pudendal
  • S2-S4
  • External uretheral sphincter contraction
  • nAChR
  • ACh
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11
Q
  • What are the two bladder reflexes and which areas of the body are responsible for each?
A
  • Storage/Guarding reflex
    • Spinal cord
  • Voiding reflex
    • Brain
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12
Q
  • *Describe the storage reflex*
    • What activates it?
    • What occurs as a result?
A
  • Bladder filling activates the storage reflex
  • Sends sympathetic and somatic outflow
  • Result: Detrusor m. relaxed and external uretheral sphincter is contracted
  • Urine is stored
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13
Q
  • *Describe the voiding reflex*
  • What activates it?
  • What occurs as a result?
A
  • Activated by a full bladder
  • Afferents send signals to spinal cord and then the brain
  • Stimulation of parasympathetics and inhibition of sympathetic/somatic outflow
  • Result: Contraction of the detrusor muscle and relaxation of the external? uretheral sphincter
  • Urine is released
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14
Q
  • What three areas of the brain are responsible for controlling bladder reflexes?
A
  • Cortex
  • Midbrain: PAG
  • Pons: PMC
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15
Q
  • What is the role of the cerebral cortex in bladder reflexes?
A
  • Interprets sensation
  • Can partially inhibit micturition reflex
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16
Q
  • What is the role of the PAG in the bladder reflex?
A
  • Receives afferent/sensory signals
  • Primary excitation input to the PMC
  • *Higher brain centers can supress or stimulate this input to the PMC*
17
Q
  • What is the role of the PMC (Pontine Micturition Center/Barrington’s Nucleus) in bladder reflex?
A
  • Receives signals from PAG and higher brain centers
  • Activates external sphincter relaxation and sacral parasympathetic outflow
  • Controls S2-S4
18
Q
  • What are characteristics of adult micturition?
A
  • Voluntary start-stop
  • Detrusor m and sphincter work in coordination
19
Q
  • What are the characteristics of infant micturition?
A
  • Involuntary start-stop
  • Voiding occurs @ lower bladder volumes
  • Detrusor m. and sphincter work in coordination
20
Q
  • What are the characteristics of paraplegic micturition?
A
  • Involuntary start-stop
  • Voiding occurs at lower urine volumes
  • Detrusor m. and sphincter are uncoordinated (detrusor-sphincter dysenergia)